Statin and PCSK9 inhibitor combination more effective at lowering cholesterol

In patients with angiographic coronary disease who have been treated with a statin, the addition of evolocumab, a PCSK9 inhibitor, led to greater low-density lipoprotein cholesterol (LDL-C) lowering and atheroma regression compared with placebo after 76 weeks of treatment, according to a study in JAMA.

Stephen J. Nicholls, MBBS, PhD, from the University of Adelaide in Australia, and colleagues conducted the double-blind, placebo-controlled, randomized GLAGOV trial at 197 academic and community hospitals in North America, Europe, South America, Asia, Australia, and South Africa. Between May 3, 2013, and January 12, 2015, 968 patients presented for coronary angiography and were enrolled in the study.

The participants had a mean age of 59.8 years, 269 (27.8%) were women, and the mean LDL-C level was 92.5 mg/dL. A total of 846 had evaluable imaging at follow-up. Compared with placebo, those who received evolocumab had lower mean, time-weighted LDL-C levels (93.0 vs 36.6 mg/dL, respectively). PAV increased 0.05% with placebo and decreased 0.95% with evolocumab. Normalized TAV decreased 0.9 mm3 with placebo and 5.8 mm3 with evolocumab. Evolocumab induced plaque regression in a greater percentage of patients compared with placebo (64.3% vs 47.3%, respectively, for PAV and 61.5% vs 48.9%, respectively, for TAV).

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